Nicotine replacement therapy

All forms of NRT increase a person's chances of stopping tobacco use. ^[3] Studies have shown that nicotine replacement therapy helps people quit smoking for at least 6 months as effectively as bupropion preparations. ^[8] Studies have also shown that all forms of NRT, including nicotine chewing gums, nasal sprays, inhalers, and resorption tablets, have similar success rates in a person who quits smoking. However, the likelihood of using the methods is different: nicotine patches are most often used, followed by chewing gums, inhalers and nasal sprays. ^[9]

It should be noted that using a combination of several NRT methods may increase the chances of stopping tobacco use. ^[8] In addition, the use of nicotine replacement therapy in combination with counseling increases rates of abstinence from tobacco. ^[5]

Nicotine replacement drugs are of the greatest practical importance for heavy smokers who smoke more than 15 cigarettes per day.

Although there is no evidence that NRT may increase the risk of developing myocardial infarction, ^{[3] a} person with a history of cardiovascular disease or recent myocardial infarction should consult a doctor before using NRT. ^[10]

Persons under 18 years of age should also consult a doctor before starting nicotine replacement therapy. ^[10]

The use of nicotine during pregnancy can lead to attention deficit hyperactivity disorder (ADHD) and a decrease in learning ability in a child. It also poses a risk of a child's nicotine addiction in the future. ^[11] Therefore, pregnant and lactating women should consult a doctor before starting NRT. ^[10] Chewing gum, resorption tablets and nasal sprays are assigned teratogenicity category C; transdermal patch - category D. The transdermal patch is considered less safe for the fetus, because nicotine enters the body continuously during the time the patch is used, unlike chewing gum or resorption tablets, which deliver nicotine periodically. ^{[11] [12]}

NRT preparations differ in the time that nicotine needs to penetrate the blood and the total time that nicotine is in the body. ^[5]

Nicotine patches applied to the skin continuously release a stable dose of nicotine for 16-24 hours. ^{[5] [12]} Nicotine from chewing gums, sprays and sublingual tablets quickly enters the body, but there is less time.

Nicotine sprays are considered the most advanced form of NRT due to their speed. As a psychologist at Kings College, Gay Sutherland, explains, “after a cigarette is puffed, nicotine enters the smoker's brain after about 20 seconds. Most forms of NRT begin to act in the range of 30 minutes to three hours, ”while the spray has a proven ability to deliver nicotine to the brain within 60 seconds. ^{[13] [14] [15]}

Clinical studies indicate a significant increase in the patient's chances of successfully quitting smoking when using an increased dose of nicotine in the patch. Clinical chewing gum doubles the chance of quitting smoking compared to placebo. ^{[16] [17]} Clinical trials have shown that a sublingual tablet is 91% more effective than placebo for 6 months. ^[18] Clinical topical spray showed efficacy 2.5 times higher compared to placebo for 52 weeks. ^[19]

To increase the effectiveness of therapy with a high and very high degree of nicotine addiction, the use of a combination of nicotine-containing drugs (patch + chewing gum) is recommended. Combination therapy is even more effective than NRT monotherapy and almost 3 times increases the chances of quitting smoking compared to placebo. ^[twenty]

Snus and snuff are also able to supply the body with nicotine without resorting to smoking, ^[21] however they cause negative health effects.

Electronic cigarettes, also known as vaporizers or electronic nicotine delivery systems (ENDS), often, although not always, reproduce the appearance and mechanism of action of cigarettes. They can be positioned by manufacturers as a less harmful alternative to cigarettes, but they do not have NRT status in any jurisdiction, and evidence of their safety and effectiveness is limited ^[22] . Nicotine levels in some electronic cigarettes and liquids for refueling are poorly regulated. The negative effects on health and their effectiveness are still being investigated, and medical organizations do not recommend electronic cigarettes as NRT.

The U.S. Food and Drug Administration (FDA) has compiled an additional list of regulated tobacco products, including electronic cigarettes. ^[23] Research suggests that drugs approved by the FDA, such as a nicotine inhaler, may be a safer way to supply nicotine than electronic cigarettes. ^[24]

The first NRT product was Nicorette chewing gum, developed in the late 1970s by the Swedish company AB Leo . ^[25] Pioneer of NZT is considered its developer, Swedish researcher Ove Ferno.

Brand names include Nicotex, Nicorette , Nicoderm, Nicogum, Nicotinell, Thrive and Commit Absorption Tablets.

• Nicotine addiction treatment
• World Health Organization Framework Convention on Tobacco Control
• World No Tobacco Day

• University of Wisconsin Center for Tobacco Research and Intervention
• Recommendations for special populations